Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Physiotherapy, Kainan Hospital, Yatomi, Japan.
J Thorac Cardiovasc Surg. 2017 Feb;153(2):373-379.e1. doi: 10.1016/j.jtcvs.2016.09.036. Epub 2016 Sep 23.
To explore the efficacy of postoperative neuromuscular electrical stimulation (NMES) on muscle protein degradation and muscle weakness in patients after cardiovascular surgery.
Sixty-one patients underwent NMES daily from postoperative days (PODs) 1 to 5 in addition to postoperative mobilization program (NMES group), and 41 patients underwent postoperative mobilization program only (non-NMES group). The primary outcome was the concentration of 3-methylhistidine (3-MH) in 24-hour urine corrected for urinary creatinine content (3-MH/Cre) from PODs 1 to 5. The secondary outcomes were knee extensor isometric strength (KEIS) and handgrip strength at POD 7.
Baseline characteristics such as age, sex, preoperative body mass index, hemoglobin, handgrip strength, KEIS, surgery type, cardiopulmonary bypass time, and immediate postoperative interleukin-6 were not different between the groups. Urinary 3-MH/Cre was increased significantly in both groups; however, urinary 3-MH/Cre in the NMES group peaked earlier compared with that in the non-NMES group. KEIS at POD 7 was significantly greater in the NMES group (median [interquartile range], 0.40 kg/weight [0.33-0.45] in the NMES group vs 0.23 kg/weight [0.15-0.36] in the non-NMES group; P < .01). Handgrip strength at POD 7 was also significantly greater in the NMES group (median [interquartile range], 32 kg [24.5-35.3] in the NMES group vs 24 kg [16.0-30.0] in the non-NMES group; P < .01).
This study demonstrated that NMES might attenuate skeletal muscle protein degradation and muscle weakness after cardiovascular surgery. A cause-effect relationship between NMES and functional preservation would be a future challenging issue.
探讨心血管手术后患者术后神经肌肉电刺激（NMES）对肌肉蛋白降解和肌肉无力的疗效。
61 例患者在术后第 1 天至第 5 天每天接受 NMES（NMES 组），外加术后活动方案，41 例患者仅接受术后活动方案（非-NMES 组）。主要结局指标是第 1 天至第 5 天 24 小时尿 3-甲基组氨酸（3-MH）浓度校正尿肌酐含量（3-MH/Cre）。次要结局指标是术后第 7 天膝关节等长伸肌强度（KEIS）和握力。
两组间年龄、性别、术前体重指数、血红蛋白、握力、KEIS、手术类型、体外循环时间和术后即刻白细胞介素-6 等基线特征无差异。两组的尿 3-MH/Cre 均显著增加；然而，NMES 组的尿 3-MH/Cre 更早达到峰值。NMES 组术后第 7 天的 KEIS 明显大于非-NMES 组（中位数[四分位数间距]，NMES 组 0.40 kg/体重[0.33-0.45]比非-NMES 组 0.23 kg/体重[0.15-0.36]；P<.01）。NMES 组术后第 7 天的握力也明显大于非-NMES 组（中位数[四分位数间距]，NMES 组 32 kg[24.5-35.3]比非-NMES 组 24 kg[16.0-30.0]；P<.01）。
本研究表明，NMES 可能减轻心血管手术后的骨骼肌蛋白降解和肌肉无力。NMES 与功能保留之间的因果关系将是未来具有挑战性的问题。
